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In this paper, we report the case of a man in his 30s with a first-episode psychosis, characterised by a subtype of delusional misidentification syndrome in which the delusion of doubles is exclusively of the patient’s own self. This subdivision can be termed ‘syndrome of doubles of the self’ or ‘syndrome of subjective doubles’. Additionally, an examination of the patient’s mental state showed paranoid delusions. After being evaluated in the emergency department, the patient was hospitalised, and medicated with antipsychotic drugs. One week later, he was discharged with total remission of psychotic symptoms. This is a rare and curious presentation of a psychotic episode, with very few similar cases described to date.

Corticosteroid-based drugs are widely used in the general population to treat several acute and chronic inflammatory conditions. However, the therapeutic efficacy of these drugs is often accompanied by severe psychiatric adverse effects through a yet unknown mechanism. To further complicate this situation, therapeutic strategies to counteract psychotic symptoms associated with these agents have yet to be devised. We report a case of a young white male Jehovah's Witness admitted to the psychiatry ward of the Maggiore della Carità Hospital, Novara, Italy. At admission, the patient presented with psychomotor agitation, auditory hallucinations, and thought disturbances, resulting in the working diagnosis of a manic episode with psychotic features. During the 16 days of his hospital admission, the patient was treated with antipsychotic medications (aripiprazole and haloperidol) and with benzodiazepines (lorazepam), and he achieved a complete remission of all psychotic symptoms. While his psychiatric history was negative, his medical records revealed a recent discharge from the infectious disease ward with a diagnosis of infectious mononucleosis treated with intravenous betamethasone. Thus, at discharge, a diagnosis of steroid-induced psychosis was made. In conclusion, our findings are suggestive of a potential role played by corticosteroids in the development of psychotic symptoms, for which routine screening protocols and therapeutic guidelines are still lacking.

Background Study aims were to analyze psychopathological details of prodromes leading to first-lifetime psychotic episodes and apply them to improve prediction of final diagnoses. Methods Comprehensive records of subjects with final diagnoses of bipolar I (BD-I; n = 216), schizoaffective (SzAffD; n = 71), or psychotic major-depressive (MDD; n = 42) disorders in the Harvard-McLean First-Psychotic Episode Project were analyzed to identify psychopathological details of prodromes leading to first-lifetime episodes with psychotic features and their ability to predict final diagnoses tested with multivariable logistic regression modeling. Results While held blind to final diagnoses, we identified 84 distinct psychopathological characteristics of prodromes to first-psychotic episodes, including perceptual disturbances, affective symptoms, sleep disturbances, onset rate, and duration. Prevalence of 19 factors appeared to differ among final diagnoses, and were tested with multivariable regression modeling. Significantly and independently more associated with final diagnoses of MDD than BD-I were 7 features: suicidal ideation, somatic delusions, anorexia, lack of insomnia, older presenting age, depressive symptoms, and lack of impulsivity; 9 others were associated more with later SzAffD than MDD or BD-I: lack of insomnia, homicidal behavior, lack of excitement, visual hallucinations, command hallucinations, longer prodrome, male sex, responding to internal stimuli, and younger age at presentation. Limitations Historical-retrospective and prospective assessments may have misidentified some prodromal features, and subjects with final psychotic-MDD diagnosis were relatively few. Conclusions Psychopathological features identified during prodromes leading to first-episodes with psychotic features predicted and distinguished among final diagnoses of MDD, BD-I, and SzAffD. The findings add to growing impressions that early psychopathology has value in predicting final diagnoses of major affective and schizoaffective disorders.

BackgroundUnderstanding the interplay between trauma-related psychological mechanisms and psychotic symptoms may improve the effectiveness of interventions for post-traumatic stress reactions in psychosis. Network theory assumes that mental health problems persist not because of a common latent variable, but from dynamic feedback loops between symptoms, thereby addressing the heterogeneous and overlapping nature of traumagenic and psychotic diagnoses. This is a proof-of-concept study examining interactions between post-traumatic stress symptoms, which were hypothesized to reflect trauma-related psychological mechanisms, and auditory hallucinations and delusions.MethodBaseline data from two randomised controlled trials (N = 216) of trauma-focused therapy in people with post-traumatic stress symptoms (87.5% met diagnostic criteria for PTSD) and psychotic disorder were analysed. Reexperiencing, hyperarousal, avoidance, trauma-related beliefs, auditory hallucinations and delusional beliefs were used to estimate a Gaussian graphical model along with expected node influence and predictability (proportion of explained variance).ResultsTrauma-related beliefs had the largest direct influence on the network and, together with hypervigilance, were implicated in the shortest paths from flashbacks to delusions and auditory hallucinations.ConclusionsThese findings are in contrast to previous research suggesting a central role for re-experiencing, emotional numbing and interpersonal avoidance in psychosis. Trauma-related beliefs were the psychological mechanism most associated with psychotic symptoms, although not all relevant mechanisms were measured. This work demonstrates that investigating multiple putative mediators may clarify which processes are most relevant to trauma-related psychosis. Further research should use network modelling to investigate how the spectrum of traumatic stress reactions play a role in psychotic symptoms.

We describe a 78-year old male patient with Parkinsonrsquo;s disease and without a past psychiatric history, who had hallucinations and a very particular form of a delusional misidentification syndrome. His belief that he was not at home and that his home was on a different location, even in another country, is a form of 'reduplicative paramnesia'. This delusion is seen more often in association with neurodegenerative disease, for example in Parkinsonrsquo;s disease. We describe the characteristics of this delusion, provide possible explanations and delineate several therapeutic options.

Folie à famille is a rare form of shared psychotic disorder. It is defined as the transfer of delusions from one person to another.This paper presents a case of shared psychotic disorder in two brothers, aged 16 and 17 and their mother who were admitted on the same day at the Clinic for psychiatry. The inducer was a mother, suffering from schizophrenia. She transferred her delusions to her sons. Both boys produced mostly the same paranoid delusions, that the others have been recording and monitoring them since their father died. After few days, the older boy, who had more severe psychotic symptoms, was treated with aripiprazole, while both received anxiolytics in low dosage.We observed a withdrawal of psychotic psychopathology in both kids. Genetic burden, social isolation and strong emotional connection of family members are factors that have contributed to the development of shared psychotic disorder in this case.The new approach of treatment for induced psychosis includes not only separation from the primary case, but also specific pharmacotherapy. It is necessary to think about this clinical entity, because this delusional disorder needs specific treatment, with better prognostic outcomes.

Background: Behavioral variant frontotemporal dementia (bvFTD) is generally considered a young-onset dementia, although age at onset is highly variable. While several studies indicate clinical differences regarding age at onset, no biomarker validated cohort studies with updated clinical criteria have been performed. Objective: We aimed to examine behavior, cognition, and mortality over the full age spectrum in a cohort of bvFTD patients with neuroimaging, genetic, or histopathological confirmation and exclusion of positive Alzheimer’s disease biomarkers or severe cerebrovascular damage. Methods: In total, 315 patients with a clinical diagnosis of probable or definite bvFTD were included from the Amsterdam Dementia Cohort and grouped into quartiles by age-at-diagnosis. Neuropsychiatric symptoms and cognitive functioning were assessed with the neuropsychiatric inventory, the geriatric depression scale and a neuropsychological test battery. Data on mortality was obtained from the Dutch municipal register. Associations between age-at-diagnosis and clinical features and mortality risk were examined. Results: Age-at-diagnosis ranged from 26 to 85 years and established quartiles with mean ages of 52±6, 61±2, 66±2, and 74±3 years. In the total sample, 44.4%exceeded an age of 65 years at time of diagnosis. Earlier age-at-diagnosis was associated with more severe behavioral symptoms, while later age-at-diagnosis was associated with more severe memory impairment. Unexpectedly, mortality risk was not associated with age-at-diagnosis. Conclusion: In bvFTD, symptom profile is associated with age-at-diagnosis. This should be taken into account with regard to diagnostics, patient management, and trial design. Additionally, based on our sample, the prevalence of late-onset bvFTD is higher than generally thought.

Othello syndrome (OS) is a type of delusional jealousy, characterized by the false absolute certainty of the infidelity of a partner. This syndrome is not uncommon in Parkinson's Disease (PD), appearing as side effect of Dopaminergic Agonists (DA) therapy. We analyze the observations of five patients with OS, diagnosed in a series of 250 consecutive PD patients during two years. All patients are men, with a particularly young age at onset of PD. The mean duration of DA therapy at OS onset was 3 years. One patient had hypersexuality and another had punding. Significant cognitive impairment was present in two patients. All patients were treated with DA: two with Pramipexol and three with Piribedil. At the time of the management of the OS, three patients had already divorced their spouse. It is imperative for clinicians to know this underestimated syndrome in order to identify it early and approach it adequately to avoid irreversible negative prejudice.

Background The content of grandiose delusions—inaccurate beliefs that one has special powers, wealth, mission, or identity—is likely to be highly meaningful. The meaning, for example providing a sense of purpose, could prove to be a key factor in the delusion taking hold. We aimed to empirically define and develop measures of the experience of meaning in grandiose delusions and the sources of this meaning, and to test whether severity of grandiosity in clinical and non-clinical populations is associated with level of meaning. Methods We did a cross-sectional self-report questionnaire study in two cohorts: non-clinical participants aged 18 years and older, with UK or Irish nationality or residence; and patients with affective or non-affective psychosis diagnoses, aged 16 years and older, and accessing secondary care mental health services in 39 National Health Service providers in England and Wales. Participants with high grandiosity completed two large item pools: one assessing the experience of meaning in grandiose delusions (Grandiosity Meaning Measure [termed gram]) and one assessing the sources of meaning (Grandiosity Meaning Measure–Sources [termed grams]). The Grandiosity Meaning Measure and Grandiosity Meaning Measure–Sources were developed using exploratory factor analysis and confirmatory factor analysis. Structural equation modelling was used to test the associations of meaning with the severity of grandiosity. The primary outcome measure for grandiosity was the Specific Psychotic Experiences Questionnaire (grandiosity subscale) and associations were tested with the Grandiosity Meaning Measure and the Grandiosity Meaning Measure–Sources. Findings From Aug 30, 2019, to Nov 21, 2020, 13 323 non-clinical participants were enrolled. 2821 (21%) were men and 10 134 (76%) were women, 11 974 (90%) were White, and the mean age was 39·5 years (SD 18·6 [range 18–93]). From March 22, 2021, to March 3, 2022, 798 patients with psychosis were enrolled. 475 (60%) were men and 313 (39%) were women, 614 (77%) were White, and the mean age was 43·4 years (SD 13·8 [range 16–81]). The experience of meaning in relation to grandiose delusions had three components: coherence, purpose, and significance. The sources of meaning had seven components: positive social perceptions, spirituality, overcoming adversity, confidence in self among others, greater good, supporting loved ones, and happiness. The measurement of meaning was invariant across clinical and non-clinical populations. In the clinical population, each person typically endorsed multiple meanings and sources of meaning for the grandiose delusion. Meaning in grandiose delusions was strongly associated with severity of grandiosity, explaining 53·5% of variance, and with grandiose delusion conviction explaining 27·4% of variance. Grandiosity was especially associated with sense of purpose, and grandiose delusion conviction with coherence. Similar findings were found for the non-clinical population. Interpretation Meaning is inherently tied to grandiose delusions. This study provides a framework for research and clinical practice to understand the different types of meaning of grandiosity. The framework is likely to have clinical use in psychological therapy to help guide patients to find sources of equivalent meaning from other areas of their lives and thereby reduce the extent to which the grandiose delusion is needed. Funding Health Education England and National Institute for Health and Care Research.

Background\ud Delusions are a common transdiagnostic feature of psychotic disorders, and their treatment remains suboptimal. Despite the pressing need to better understand the nature, meaning, and course of these symptoms, research into the lived experience of delusional phenomena in psychosis is scarce. Thus, we aimed to explore the lived experience and subjective apprehension of delusions in help-seeking individuals with psychosis, regardless of diagnosis and thematic content of the delusion.\ud Methods\ud In our systematic review and qualitative evidence synthesis, we searched MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science for qualitative studies published in English from database inception, with the last search on Sept 9, 2021. Grey literature search and hand-searching of relevant journals were also done. Studies were eligible if they provided an analysis of lived experience of delusions or predelusional phenomena presented from the perspective of individuals (age 14–65 years) who had developed a clinical high-risk stage of psychosis, or a diagnosable affective or non-affective psychotic disorder (as clinically defined, self-reported, or assessed within the primary study). Studies with only a subset of relevant participants were eligible only if data for the population of interest were reported separately. Studies that did not discriminate between the experience of delusion and other positive symptoms (eg, hallucinations) were included only if data for delusions were reported separately or could be extracted. First-person accounts (and author interpretations) discussing changes in the sense of self, lived world, and meaning in relation to delusions were extracted and synthesised using a novel thematic synthesis approach informed by a critical realist stance and a phenomenological theoretical framework. Analytic themes were developed into a new overarching framework for understanding the emergence of delusional phenomena. The study was registered with PROSPERO, CRD42020222104.\ud Findings\ud Of the 3265 records screened, 2115 were identified after duplicate removal. Of these, 1982 were excluded after title and abstract screening and 106 after full-text eligibility assessment. Of the 27 studies entering quality assessment, 24 eligible studies were included in the qualitative evidence synthesis, representing the perspectives of 373 help-seeking individuals with lived experience of delusions in the context of psychosis. Gender was reported as male (n=210), female (n=110), transgender (n=1), or not reported (n=52). Only 13 studies reported ethnicity, with White being predominant. The age of most participants ranged from 15 to 65 years. We found no eligible studies investigating subclinical or predelusional experiences in at-risk mental state populations through qualitative methods. Most studies were undertaken in western, educated, industrialised, rich, and democratic (WEIRD) societies, and most included participants had received or self-reported a diagnosis within the schizophrenia spectrum. Studies differed in relation to whether they focused on one kind or theme of delusion or delusional phenomena more generally as a unified category. Three superordinate themes relating to experiential changes and meanings in delusion were identified: (1) a radical rearrangement of the lived world dominated by intense emotions; (2) doubting, losing, and finding oneself again within delusional realities; and (3) searching for meaning, belonging, and coherence beyond mere dysfunction. Based on the review findings and thematic synthesis, we propose the Emergence Model of Delusion to advance understanding of delusional phenomena in psychosis.\ud Interpretation\ud Delusions are best understood as strongly individualised and inherently complex phenomena emerging from a dynamic interplay between interdependent subpersonal, personal, interpersonal, and sociocultural processes. Integrative approaches to research on delusion, which consider their potential adaptiveness and favour explanatory pluralism, might be advantageous. Effective clinical care for individuals with psychosis might need adapting to match more closely, and take account of, the subjective experience and meaning of delusions as they are lived through, which might also help redress power imbalances and enduring epistemic injustices in mental health.\ud Funding\ud Priestley Scholars, Wellcome Trust.

Cannabis use characteristics, such as earlier initiation and frequent use, have been associated with an increased risk for developing psychotic experiences and psychotic disorders. However, little is known how these characteristics relate to specific aspects of sub-clinical psychopathology in the general population. Here, we explore the relationships between cannabis use characteristics and psychopathology in a large general population sample (N = 2,544, mean age 29.2 years, 47% women) by employing a network approach. This allows for the identification of unique associations between two cannabis use characteristics (lifetime cumulative frequency of cannabis use, age of cannabis use initiation), and specific psychotic experiences and affective symptoms, while controlling for early risk factors (childhood trauma, urban upbringing). We found particularly pronounced unique positive associations between frequency of cannabis use and specific delusional experiences (persecutory delusions and thought broadcasting). Age of cannabis use initiation was negatively related to visual hallucinatory experiences and irritability, implying that these experiences become more likely the earlier use is initiated. Earlier initiation, but not lifetime frequency of cannabis use, was related to early risk factors. These findings suggest that cannabis use characteristics may contribute differentially to risk for specific psychotic experiences and affective symptoms in the general population.

In schizophrenia research, patients who "jump to conclusions" in probabilistic reasoning tasks tend to display impaired decision-making and delusional belief. In five studies, we examined whether jumping to conclusions (JTC) was similarly associated with decision impairments in a nonclinical sample, such as reasoning errors, false belief, overconfidence, and diminished learning. In Studies 1a and 1b, JTC was associated with errors stimulated by automatic reasoning, oddball beliefs such as conspiracy theories, and overconfidence. We traced these deficits to an absence of controlled processing rather than to an undue impact of automatic thinking, while ruling out roles for plausible alternative individual differences. In Studies 2 and 3, JTC was associated with higher confidence despite diminished performance in a novel probabilistic learning task (i.e., diagnosing illnesses), in part because those who exhibited JTC behavior were prone to overly exuberant theorizing, with no or little data, about how to approach the task early on. In Study 4, we adapted intervention materials used in schizophrenia treatment to train participants to avoid JCT. The intervention quelled overconfidence in the probabilistic learning task. In summary, this research suggests that a fruitful crosstalk may exist between research on psychopathology and work on social cognition within the general public. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This study was funded by the Medical Research Council, the European Community’s Seventh Framework Program grant [agreement HEALTH-F2-2009-241909 (Project EU-GEI)], São Paulo Research Foundation (grant 2012/0417-0), the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King’s College London, the NIHR BRC at University College London and the Wellcome Trust (grant 101272/Z/12/Z)., Tripoli, G., Quattrone, D., Ferraro, L., Gayer-Anderson, C., Rodriguez, V., La Cascia, C., La Barbera, D., Sartorio, C., Seminerio, F., Tarricone, I., Berardi, D., Szöke, A., Arango, C., Tortelli, A., Llorca, P.-M., De Haan, L., Velthorst, E., Bobes, J., Bernardo, M., Sanjuán, J., Santos, J.L., Arrojo, M., Del-Ben, C.M., Menezes, P.R., Selten, J.-P., Jones, P.B., Jongsma, H.E., Kirkbride, J.B., Lasalvia, A., Tosato, S., Richards, A., O'donovan, M., Rutten, B.P.F., Os, J.V., Morgan, C., Sham, P.C., Murray, R.M., Murray, G.K., Di Forti, M.

Sleep-related problems are prevalent in patients with psychotic disorders, yet their contribution to fluctuations in delusional experiences is less clear. This study combined actigraphy and experience-sampling methodology (ESM) to capture the relation between sleep and next-day persecutory symptoms in patients with psychosis and prevailing delusions. Individuals with current persecutory delusions (PD; n = 67) and healthy controls (HC; n = 39) were assessed over 6 consecutive days. Objective sleep and circadian rhythm measures were assessed using actigraphy. Every morning upon awakening, subjective sleep quality was measured using ESM. Momentary assessments of affect and persecutory symptoms were gathered at 10 random time points each day using ESM. Robust linear mixed modeling was performed to assess the predictive value of sleep measures on affect and daytime persecutory symptoms. PD showed significantly lower scores for subjective quality of sleep but significantly higher actigraphic-measured sleep duration and efficiency compared with HC. Circadian rhythm disruption was associated with more pronounced severity of persecutory symptoms in HC. Low actigraphy-derived sleep efficiency was predictive of next-day persecutory symptoms in the combined sample. Negative affect was partly associated with sleep measures and persecutory symptoms. Our results imply an immediate relationship between disrupted sleep and persecutory symptoms in day-to-day life. They also emphasize the relevance of circadian rhythm disruption for persecutory symptoms. Therapeutic interventions that aim to reduce persecutory symptoms could benefit from including modules aimed at improving sleep efficacy, stabilizing sleep-wake patterns, and reducing negative affect. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: Depressive disorders, despite being classified as mood or affective disorders, are known to include disturbances in the experience of body, space, time, and intersubjectivity. However, current diagnostic manuals largely ignore these aspects of depressive experience. In this article, we use phenomenological accounts of embodiment as a theoretical foundation for a qualitative study of abnormal body phenomena (ABP) in depressive disorders. Methods: 550 patients affected by schizophrenic and affective disorders were interviewed in a clinical setting. Interviews sought to uncover the qualitative features of experiences through self-descriptions. Clinical files were subsequently digitized and re-examined using consensual qualitative research. Results: Ninety-nine out of 100 patients with MDD reported at least one ABP. From cross-analysis of the MDD sample, we obtained 4 general categories of ABP, 3 of which had additional subcategories. The 4 categories include slowed embodied temporality (N = 90), anomalous vital rhythms (N = 82), worries about one’s body (N = 22), and body deformation (N = 47). Conclusions: The results provide empirical evidence in support of theoretical discussions of embodiment in MDD found in the work of classical and contemporary phenomenologists. The findings also provide nuanced insight into the experience of persons living with MDD. Some categories of ABP, like slowed embodied temporality, can help to finely characterize psychomotor retardation or the so-called “medically unexplained symptoms” (MUS). This fine-tuned characterization can help to connect MUS to neuropsychological and neurobiological (e.g., alterations of interoceptive processes linked to anomalies of the brain resting-state hypothesis) and inflammatory (e.g., studies linking environmental stressors, inflammation mediators, and neurovegetative and affective symptoms) models of MDD. Our results can also support a pathogenic model of MDD, which posits, on the phenomenal level, ABP as the point of departure for the development of secondary symptoms including cognitive elaborations of these, namely, delusions about the body. Moreover, some of the categories, when contrasted with phenomenological qualitative studies of other disorders, provide conceptual resources of differential diagnosis and of identifying a “depressive core syndrome.” For example, findings within category 4, deformation of the body, provide resources for using ABP to distinguish between MDD and schizophrenia.

Background: Comprehensive clinicopathological studies of neuropsychiatric symptoms (NPS) in dementia are lacking. Objective: To describe the pathological correlations of NPS in a sample of institutionalized people with dementia. Methods: We studied 59 people who were consecutively admitted to a nursing home and donated their brain. Correlations between pathological variables and NPS upon admission (n = 59) and at one-year follow-up assessment (n = 46) were explored and confirmed using bivariate and multivariate statistical methods. Results: Mean (SD) age at admission was 83.2 (6.4) years and mean (SD) age at demise was 85.4 (6.6); 73% of the subjects were female and 98% presented advanced dementia. The most frequent etiological diagnosis was Alzheimer’s disease (AD; 74.6% clinical diagnosis, 67.8% pathological diagnosis). The pathological diagnosis of AD was associated with aggression (β est 0.31), depression (β est 0.31), anxiety (β est 0.38), and irritability (β est 0.28). Tau stage correlated with aggressive symptoms (β est 0.32) and anxiety (βest 0.33). Coexistence of AD and Lewy body pathology was associated with depression (β est 0.32), while argyrophilic grains were associated with eating symptoms (β est 0.29). Predictive models were achieved for apathy, including cognitive performance, basal ganglia ischemic lesions, and sex as predictors (R2 0.38) and for sleep disorders, including pathological diagnosis of AD and age at demise (R2 0.18) (all p-values

Auditory-verbal hallucinations (AVH) are a key symptom of schizophrenia. Recent neuroimaging studies examining dynamic functional connectivity suggest that disrupted dynamic interactions between brain networks characterize complex symptoms in mental illness including schizophrenia. Studying dynamic connectivity may be especially relevant for hallucinations, given their fluctuating phenomenology. Indeed, it remains unknown whether AVH in schizophrenia are directly related to altered dynamic connectivity within and between key brain networks involved in auditory perception and language, emotion processing, and top-down control. In this study, we used dynamic connectivity approaches including sliding window and k-means to examine dynamic interactions among brain networks in schizophrenia patients with and without a recent history of AVH. Dynamic brain network analysis revealed that patients with AVH spent less time in a ‘network-antagonistic’ brain state where the default mode network (DMN) and the language network were anti-correlated, and had lower probability to switch into this brain state. Moreover, patients with AVH showed a lower connectivity within the language network and the auditory network, and lower connectivity was observed between the executive control and the language networks in certain dynamic states. Our study provides the first neuroimaging evidence of altered dynamic brain networks for understanding neural mechanisms of AVH in schizophrenia. The findings may inform and further strengthen cognitive models of AVH that aid the development of new coping strategies for patients. Electronic supplementary material The online version of this article (10.1007/s00429-020-02119-1) contains supplementary material, which is available to authorized users.

Individuals with neurocognitive disorders (NCD) frequently experience psychotic symptoms, such as delusions. Delusions can contribute to other behavior problems, create dangers for patients and caregivers, and contribute to inpatient hospitalization of individuals with NCD. The current study aimed to identify cognitive symptoms associated with the presence of delusions and to differentiate delusion types based on cognitive profiles among hospitalized older adults with NCD. A review of electronic medical records of hospitalized older adults from an inpatient geriatric psychiatry setting yielded 185 patients with a diagnosis of mild or major NCD who had a neuropsychological evaluation during their admission and whose documentation described a clear delusion. We identified a comparison group of 185 patients without delusions well matched for age, education, and sex, and similar in global cognitive status. Exclusion criteria included delirium and history of a psychotic disorder. We first compared the groups' performances on a dementia battery. Then, cognitive performances of subgroups with specific delusion types (harm, theft, jealousy, and misidentification) were each compared to the remainder of the delusion-positive group. Exploratory analyses revealed that the delusion-positive group had a greater rate of discontinuation on Trails B and performed worse than the delusion-negative group on Trails A, Behavioral Dyscontrol Scale, Semantic Fluency, and Hopkins Verbal Learning Test-Revised (HVLT-R) initial registration. Theft delusions were associated with worse performance on HVLT-R recognition, misidentification delusions were associated with worse performance on Trails B, and harm delusions were associated with worse performance on a verbal generativity test. The presence of delusions in hospitalized older adults with NCD was associated with worse performance on several cognitive tasks with many being suggestive of associated with frontal-subcortical network integrity. Delusions of theft may be a consequence of reduced integrity of medial temporal lobe memory system.

Here we describe a rare case of Capgras delusion - a misidentification syndrome characterized by the belief that a person has been replaced by an imposter - in a patient without evident neurological or psychiatric symptoms. Intriguingly, delusional belief was selective for both person and modality, as the patient believed that his son - not his daughter or other relatives - was substituted with an imposter only while being in presence of him and looking at his face, but not when merely listening to his voice. A neuroanatomical reconstruction obtained integrating morphological and functional patient's neuroimaging data highlighted two main peculiarities: a compression of the rostral portion of right temporal lobe due to a large arachnoid cyst, and a bilaterally reduced metabolism of frontal areas. Autonomic data obtained from thermal infra-red camera and skin conductance recordings showed that a higher sympathetic activation was evoked by the observation of daughter's face, relative to the observation of the son's face as well as of not-familiar faces; conversely, daughter and son voices elicited a similar sympathetic activation, higher relative to not-familiar voices, indicating a modality-dependent dissociation consistent with the delusional behavior. Our case supports the "two-hit hypothesis" about Capgras delusion etiopathogenesis: here, the first hit is represented by the right-temporal lesion impairing the association between familiar faces and emotional values, the second one is the frontal bilateral hypometabolism favoring delusional behavior. The selective occurrence of "imposter" delusion for a particular subject and for a specific perceptual modality suggests the involvement of modality-specific interactions in the retrieval of affective properties during familiar people recognition.

Despite being an infrequent crime, parental homicide has been associated with schizophrenia spectrum disorders in adult perpetrators and a history of child abuse and family violence in adolescent perpetrators. Among severe psychiatric disorders there is initial evidence that delusional misidentification might also play a role in parricide. Parricides are often committed with undue violence and may result in overkill. The authors present the case of an adult male affected by schizoaffective disorder and Capgras syndrome who committed patricide. Forensic pathologists classify such cases as overkill by multiple fatal means comprising stabbing, blunt trauma and choking. Accurate crime scene investigations coupled with psychiatric examinations of perpetrator allow reconstruction of the murder stages. This overkill case is discussed in the context of a broad review of the literature.

The impact of the COVID-19 pandemic on psychosis remains to be established. Here we report 6 cases (3 male and 3 female) of first-episode psychosis (FEP) admitted to our hospital in the second month of national lockdown. All patients underwent routine laboratory tests and a standardized assessment of psychopathology. Hospitalization was required due to the severity of behavioral abnormalities in the context of a full-blown psychosis (the Brief Psychiatric Rating Scale [BPRS] = 75.8 ± 14.6). Blood tests, toxicological urine screening, and brain imaging were unremarkable, with the exception of a mild cortical atrophy in the eldest patient (male, 73 years). All patients were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout their stay, but 3 presented the somatic delusion of being infected. Of note, all 6 cases had religious/spiritual delusions and hallucinatory contents. Despite a generally advanced age (53.3 ± 15.6), all patients had a negative psychiatric history. Rapid discharge (length of stay = 13.8 ± 6.9) with remission of symptoms (BPRS = 27.5 ± 3.1) and satisfactory insight were possible after relatively low-dose antipsychotic treatment (Olanzapine-equivalents = 10.1 ± 5.1 mg). Brief psychotic disorder/acute and transient psychotic disorder diagnoses were confirmed during follow-up visits in all 6 cases. The youngest patient (female, 23 years) also satisfied the available criteria for brief limited intermittent psychotic symptoms. Although research on larger populations is necessary, our preliminary observation suggests that intense psychosocial stress associated with a novel, potentially fatal disease and national lockdown restrictions might be a trigger for FEP.

Various studies have demonstrated associations between personality disorders and relationship satisfaction. The authors examine the associations between attention seeking and grandiosity, both features of narcissistic personality disorder, and relationship satisfaction before and after the transition to parenthood. The authors then expand their analysis to parental satisfaction and postpartum depression (PPD). Nonclinical couples (N = 103 couples) expecting their first child completed measures of grandiosity, attention seeking, and relationship satisfaction before birth, and of relationship satisfaction, parental satisfaction, and PPD symptoms 3 months afterward. Attention seeking was associated with less parental satisfaction and more PPD symptoms, and with less prepartum relationship satisfaction for participants' partners. For men, attention seeking was also associated with prepartum relationship satisfaction. Grandiosity was associated with a decrease in relationship satisfaction after birth, although, surprisingly with fewer PPD symptoms for participants’ partners. The authors discuss how these findings might be related to changes in social support and work–life balance during the transition to parenthood.

Repetitive transcranial magnetic stimulation (rTMS), when applied to left dorsolateral prefrontal cortex (LDLPFC), reduces negative symptoms of schizophrenia, but has no effect on positive symptoms. In a small number of cases, it appears to worsen the severity of positive symptoms. It has been hypothesized that high-frequency rTMS of the LDLPFC might increase the dopaminergic neurotransmission by driving the activity of the left striatum in the basal ganglia (LSTR)—increasing striatal dopaminergic activity. This hypothesis relies on the assumption that either the frontal–striatal connection or the intrinsic frontal and/or striatal connections covary with the severity of positive symptoms. The current work aimed to evaluate this assumption by studying the association between positive and negative symptoms severity and the effective connectivity within the frontal and striatal network using dynamic causal modeling of resting state fMRI in a sample of 19 first episode psychosis subjects. We found that the total score of positive symptoms of schizophrenia is strongly associated with the frontostriatal circuitry. Stronger intrinsic inhibitory tone of LDLPFC and LSTR, as well as decreased bidirectional excitatory influence between the LDLPFC and the LSTR is related to the severity of positive symptoms, especially delusions. We interpret that an increase in striatal dopaminergic tone that underlies positive symptoms is likely associated with increased prefrontal inhibitory tone, strengthening the frontostriatal ‘brake’. Furthermore, based on our model, we propose that lessening of positive symptoms could be achieved by means of continuous theta-burst or low-frequency (1 Hz) rTMS of the prefrontal area.

Experimental research has shown that poor sleep triggers psychotic experiences, even in healthy participants. This warrants an in-depth investigation of this mechanism in a naturalistic environment, an exploration of which particular aspects of poor sleep trigger psychotic symptoms, and a test for reverse effects of symptoms on sleep. For this purpose, we conducted a 14-day ambulatory assessment study with 82 young adults (age: M = 21.24 years, SD = 1.54; 64.6% female), half of which were characterized by elevated psychosis proneness. Objective sleep parameters (actigraphically-measured sleep time, wake after sleep onset, sleep efficiency), self-reported sleep parameters (feeling rested, dream recall, dream valence), and psychotic symptoms (paranoid symptoms, hallucinatory experiences) were assessed once per day. Using multilevel regressions (928 data points), we found that shorter sleep time and negative dream valence predicted paranoid symptoms, whereas feeling less rested and dream recall predicted hallucinatory experiences. In participants with elevated psychosis proneness, associations with the aforementioned sleep parameters were increased for hallucinatory experiences but not for paranoid symptoms. Finally, we found bidirectional associations between poor sleep and paranoid symptoms but only unidirectional associations between poor sleep and hallucinatory experiences. The findings corroborate the relevance of sleep disturbance as a predictor of psychotic experiences. Future studies should further investigate the potential of sleep interventions to prevent psychotic symptoms and disorders.

Pseudologia fantastica (PF), also known as mythomania or pathologic lying, is a well-known yet controversial phenomenon in psychiatry. There is no firm conceptualization of PF, nor are there any widely accepted diagnostic criteria for PF. The condition may be related to low self-esteem, and it shows some overlap with narcissistic personality disorder and other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cluster B personality disorders. Given the mysteriousness and rarity of PF, there is a dearth of information to guide diagnosis and even more limited information about effective treatments. Here, we discuss a case in which an adult male patient exhibited protracted symptoms that were consistent with PF, which consisted of elaborate falsifications pertaining to a history of military service that had duped even close family members. We describe the patient's presentation and the careful process of confrontation and acquisition of collateral information used to reach the diagnosis, along with the patient's efforts to avoid accepting the truth by constructing a series of even more elaborate stories. Finally, we underscore the importance of maintaining a therapeutic alliance in caring for patients with PF through frequent displays of uniform positive regard, and we describe the approach to treatment used during the patient's hospital stay.

Individuals with psychosis report employing more maladaptive and less adaptive emotion regulation (ER) strategies compared to nonclinical controls (NCs). However, it is unknown whether this is predictive of affect experienced in daily life and whether ER strategies are used less frequently and effectively by individuals with psychosis in daily life. Individuals with psychosis and current delusions (PDs; n = 71) and NCs (n = 42) completed questionnaires of habitual ER and experience sampling over 6 consecutive days, in which they reported 10 times a day on the presence of negative and positive affect and deployment of ER strategies (reappraisal, acceptance, awareness, suppression, rumination, distraction, and social sharing). Effectiveness of strategy use was operationalized by examining successive differences in positive and negative affect. Multilevel regression analyses were conducted. Questionnaires of habitual ER were largely predictive of affect in daily life. There was indication of a more frequent use of putatively maladaptive strategies but either no differences in individual adaptive strategies or even a more frequent use (reappraisal) in PDs compared to NCs. Several ER strategies (e.g., reappraisal, rumination) proved effective in reducing negative affect by the next prompt, independent of group, but suppression was effective in only PDs and acceptance had unfavorable effects in both groups. Thus, PDs demonstrated an increased use of ER strategies in daily life, of which the majority helped them to reduce negative affect. This indicates that their increased levels of negative affect are not explicable by difficulties in deploying explicit ER strategies. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The de Clérambault syndrome, commonly known as erotomania, is a delusional disorder in which the patient is convinced that another person has fallen in love with him or her. The syndrome is more frequent in female patients, who usually believe that their lover is a man belonging to a higher social and economic class, or is married, unknown, or even imaginary or deceased person. The course of the syndrome is usually chronic, with serious problematic behavioural consequences, including stalking behaviours, such as repetitive calling, unexpected visits or continuous attempts to send gifts or letters. According to the DSM-5, this syndrome is included in the erotomanic type of the delusional disorder, however, it is usually neglected in psychiatric practice and almost forgotten by modern psychiatrists.

Background: Traditional healers are considered one of the important stages in the pathway to care of schizophrenia patients because of the confidence in the system, affordability and accessibility of the service, exposing patients to hazardous management, delay in seeking psychiatric help and bad prognosis. Aim: To assess the pathway to care of schizophrenia patients and role of traditional healers into it, the sociodemographic and clinical correlates of those patients. Methods: We assessed 232 patients with schizophrenia after confirmation of diagnosis with Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) research version using a questionnaire designed by authors to assess help seeking behavior in schizophrenia patients and its sociodemographic and clinical correlates. Positive and Negative Syndrome Scale to identify the presence and severity of symptoms. Results: A total of 41.8% sought traditional healers first, 58.1% sought a psychiatric consultation first, main symptoms related to traditional healers seeking were hallucinations in 51.5%, delusions 29.9%, 9.28% bizarre behavior and 9.28% formal though disorder. Main causes of traditional healers’ preference were society acceptance 30.39%, affordability 24.74% and accessibility 16.49%. Conclusion: This study shows that a significant percentage of the patients suffering from schizophrenia prefer to approach faith healers first due to their own beliefs, society acceptance, affordability and easy accessibility.

Background and objectives: Social anxiety disorder is a common comorbidity in psychotic disorders and impacts significantly on functioning and recovery. Conflicting theories and evidence exist on i...

Virtual reality-assisted cognitive-behavioural therapy (VR-CBT) has potential to support people who experience paranoid ideation in social settings. However, virtual reality (VR) research using overt social environments is limited, and lack of qualitative studies on paranoid ideation in VR restricts understanding. This study aimed to use predominantly qualitative methods to investigate subjective experience of paranoia in VR and identify target domains for VR-CBT. Participants (N = 36) were non-clinical adults with high trait paranoia, who entered an interactive VR bar-room environment. After VR, they participated in brief audiotaped semi-structured interviews designed for measuring persecutory ideation in virtual environments. Researchers scored transcripts on the Comprehensive Assessment of At-Risk Mental States Non-Bizarre Ideas Global Rating Scale to rate the state paranoia represented by interview content. Thematic analysis of interviews employed superordinate themes of Social Evaluative Concerns, Ideas of Reference, and Ideas of Persecution to investigate participants' experience of paranoia. Mean score on the Non-Bizarre Ideas scale was 3.06 (standard deviation 1.24, range 1-6), indicating "moderate" attenuated-paranoid experiences. Nearly all participants reported Social Evaluative Concerns (N = 35) and Ideas of Reference (N = 32); half reported Ideas of Persecution (N = 19). Twelve subthemes were identified. Notably, participants believed they did not belong in the environment (N = 31), that they were the object of discussion (N = 20), and that they felt avatars were unfriendly (N = 27) and intentionally rejected them (N = 13). Subthemes reflect interpersonal and social processes that may constitute target areas for VR-CBT, for example, cognitive appraisals and social skills. Identification of these domains indicates how personalized VR-CBT may be operationalized.

Etiological models highlight the importance of emotions for the emergence of persecutory ideation. To increase our understanding of their exacerbation, we tested whether this process can be explained by a vicious cycle of negative emotions and persecutory ideation in daily life. Furthermore, we examined whether this process differs in people with and without a psychotic disorder by testing a sample of 34 individuals with elevated psychotic experiences without a diagnosis (subclinical sample) and a sample of 33 individuals diagnosed with schizophrenia spectrum disorder (clinical sample). In both samples, we applied the experience sampling method for 1 week to acquire repeated measures of sadness, fear, anger, shame, and persecutory ideation. Multilevel models showed that all tested negative emotions were associated with persecutory ideation measured at the same time point (p < .05) in both samples. Fear predicted subsequent persecutory ideation (p < .05). There was a moderating effect between sample and anger and sample and sadness predicting subsequent persecutory ideation (p < .05), with these associations being stronger in the subclinical sample. Finally, persecutory ideation predicted subsequent fear, anger, sadness, and shame (p < .05) without a moderating effect of the sample. Hence, the results showed an emotion-unspecific rather than an emotion-specific vicious cycle of negative emotions and persecutory ideation, which possibly contributes to symptom exacerbation and maintenance. Potential differences in mechanisms relating to emotions and persecutory ideation before and after the manifestation of the disorder are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

OBJECTIVE: Psychotic experiences affect more than 10% of children and often co-occur with nonpsychotic mental disorders. However, longitudinal studies of the outcome of psychotic experiences based on unbiased information on mental health service use and psychotropic medications are scarce. The authors investigated whether psychotic experiences at ages 11-12 predicted a psychiatric diagnosis or treatment with psychotropic medications by ages 16-17. METHODS: In a longitudinal register-based follow-up study of the Copenhagen Child Cohort 2000, a total of 1,632 children ages 11-12 were assessed for psychotic experiences in face-to-face interviews. The children were also assessed for mental disorders and IQ. National registries provided information on perinatal and sociodemographic characteristics, on psychiatric disorders diagnosed at child and adolescent mental health services, and on prescribed psychotropic medications through ages 16-17. RESULTS: Among children who had not been previously diagnosed, and after adjustment for sociodemographic and perinatal adversities and IQ, psychotic experiences at ages 11-12 predicted receiving a psychiatric diagnosis in child and adolescent mental health services before ages 16-17 (adjusted hazard ratio=3.13, 95% CI=1.93, 5.07). The risk was increased if the child met criteria for a co-occurring mental disorder (not diagnosed in mental health settings) at baseline compared with no psychotic experiences or diagnosis at baseline (adjusted hazard ratio=7.85, 95% CI=3.94, 15.63), but having psychotic experiences alone still marked a significantly increased risk of later psychiatric diagnoses (adjusted hazard ratio=2.76, 95% CI=1.48, 5.13). Similar patterns were found for treatment with psychotropic medications. CONCLUSIONS: Psychotic experiences in childhood predict mental health service use and use of psychotropic medications during adolescence. The study findings provide strong evidence that psychotic experiences in preadolescence index a transdiagnostic vulnerability for diagnosed psychopathology in adolescence.

BackgroundChange in the experience of oneself may lay the groundwork for the development of additional hallucinations and delusions in individuals with schizophrenia. However, to date, the course and symptom and functioning correlates of passivity symptoms (cf. thought insertion, thought withdrawal) have not been measured consistently over long periods of time. Information on the course and correlates of passivity symptoms is essential for developing models of their contribution to schizophrenic illness.MethodEighty-two individuals diagnosed with schizophrenia or schizoaffective disorder were recruited at an index hospitalization and reassessed at three or more follow-ups over the following 18 years.ResultsThe results indicate that a small group of participants report passivity symptoms at all follow-ups, many reported passivity symptoms at some follow-ups, and the majority of individuals never reported passivity symptoms. The prevalence of passivity symptoms was similar to that for delusions of reference and persecutory delusions. Notably, when individuals did experience passivity symptoms, they also had a greater number of additional psychotic symptoms than individuals without passivity symptoms. Further, the presence of passivity symptoms was associated with work impairment at some assessments.ConclusionsPassivity symptoms present episodically, at a similar rate as delusions of reference and persecutory delusions, and when present, they are associated with having a higher number of additional psychotic symptoms, as well as having some impact on work functioning. These results suggest that passivity symptoms may increase vulnerability to additional psychotic symptoms and greater work impairment.

Background People with schizophrenia are ten times more likely to commit homicide than a member of the general population. The relationship between symptoms of schizophrenia and acts of violence is unclear. There has also been limited research on what determines the seriousness and form of violence, such as reactive or instrumental violence. Moral cognition may play a paradoxical role in acts of violence for people with schizophrenia. Thoughts which have moral content arising from psychotic symptoms may be a cause of serious violence. Method We investigated if psychotic symptoms and moral cognitions at the time of a violent act were associated with acts of violence using a cross-sectional national forensic cohort (n = 55). We examined whether moral cognitions were associated with violence when controlling for neurocognition and violence proneness. We explored the association between all psychotic symptoms present at the time of the violent act, psychotic symptoms judged relevant to the violent act and moral cognitions present at that time. Using mediation analysis, we examined whether moral cognitions were the missing link between symptoms and the relevance of symptoms for violence. We also investigated if specific moral cognitions mediated the relationship between specific psychotic symptoms, the seriousness of violence (including homicide), and the form of violence. Results Psychotic symptoms generally were not associated with the seriousness or form of violence. However, specific moral cognitions were associated with the seriousness and form of violence even when controlling for neurocognition and violence proneness. Specific moral cognitions were associated with specific psychotic symptoms present and relevant to violence. Moral cognitions mediated the relationship between the presence of specific psychotic symptoms and their relevance for violence, homicide, seriousness of violence, and the form of violence. Conclusions Moral cognitions including the need to reduce suffering, responding to an act of injustice or betrayal, the desire to comply with authority, or the wish to punish impure or disgusting behaviour, may be a key mediator explaining the relationship between psychotic symptoms and acts of violence. Our findings may have important implications for risk assessment, treatment and violence prevention.

Introduction: Jumping to conclusions is associated with delusions. It is unclear whether positive schizotypy, which refers to delusion-like and hallucination-like symptoms, is associated wi...

Background: Depressive state is a common complication of spinocerebellar ataxia type 3 (SCA3). To the best of our knowledge, cases of SCA3 presenting with psychotic symptoms (i.e., cenesthopathy) have not been described. Here, we present a case of severe depressive state with cenesthopathy and delusion in a young Japanese man with SCA3.Case presentation: A 43-year-old Japanese man with SCA3 developed severe depressive state with associated cenesthopathy and delusion. He was treated with escitalopram (10 mg/day) and olanzapine (2.5 mg/day). Computed tomography showed atrophy of the cerebellum, bilateral superior cerebellar peduncle, and tegmentum of the pons. Single-photon emission computed tomography demonstrated reduced blood flow in the cerebellum, vermis, and brainstem. After eight weeks, his depressive state and delusion improved however his cenesthopathy persisted. Conclusions: We encountered a case of severe state with psychotic features (i.e., cenesthopathy and delusion) in a young Japanese man with SCA3. This study demonstrates that SCA3 may inherently present with severe depressive state and unique psychotic symptoms, even in younger patients where age-related neurodegeneration is unlikely. The complex function of the cerebellum in emotion and perception may play a crucial in the emergence of these psychiatric symptoms.

The sociocultural context of psychiatric patients shapes symptoms experience and expression, as well as how patients deal with a disorder and how society appraises its symptoms. Specifically, the context may influence the social appraisal of a behavior as normal or pathological. Therefore, markedly pathological symptoms may not be accordingly recognized by peers when they are in consonance with the sociocultural context. Per “Dead” Ohlin was a Swedish musician who was a member of the Norwegian black metal band Mayhem from 1988 until his suicide in 1991, at age 22. Black metal is a musical movement characterized by death worshiping and anti-Christianism, and is also associated with church arsons and murders during the 1990s. Even among peculiar personalities such as black metal musicians, Ohlin was considered the personification of the movement ideals due to his eccentric and unparalleled beliefs and behaviors, claiming, for instance, that he was already dead. In this article, we propose that Ohlin's eccentric beliefs and behaviors were symptoms of an unrecognized psychiatric condition, Cotard's syndrome, and discuss the diagnostic dilemma presented by Ohlin's artistic persona and singular context. The compatibility between his symptoms and the sociocultural context of black metal may have obscured his mental disorder. If so, Ohlin's unique case may shed light upon one of the effects of context in a psychopathological process: concealing a psychiatric disorder and reinforcing symptoms that fit a particular environment.